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Canadian Journal of Anaesthesia

, Volume 42, Issue 11, pp 1010–1016 | Cite as

The triple airway manoeuvre for insertion of the laryngeal mask airway in paralyzed patients

  • Kazuyoshi Aoyama
  • Ichiro Takenaka
  • Takeyoshi Sata
  • Akio Shigematsu
Reports of Investigation

Abstract

The efficacy of the triple airway manoeuvre (mouth opening, head extension and jaw thrust) for insertion of the laryngeal mask airway (LMA) was compared with the standard insertion method. One hundred paralyzed patients were allocated randomly into two groups: in the control group (n = 50) the LMA was inserted by the standard method, and in the other (TAM group, n = 50) by the triple airway manoeuvre. In ten patients of each group, the position of the LMA and the epiglottis was assessed radiographically before insertion, after insertion but before cuff inflation, and after cuff inflation. In all patients the position was examined using fibrescopy before and after cuff inflation. The mean distance between the epiglottis and the posterior pharyngeal wall, measured radiographically before LMA insertion, was greater in the TAM group (16.3 (SD 4.3) mm) than in the control group (7.0 (2.8) mm) (P < 0.001). Before cuff inflation, radiography and fibrescopy showed that the LMA compressed the epiglottis downwards more frequently in the control group. After cuff inflation the glottis was completely visible fibreoptically in 66% in the TAM group, compared with 14% in the control group (P < 0.001). Complete downfolding of the epiglottis was seen in 10% in the control group and none in the TAM group (P < 0.05). We conclude that in paralyzed patients LMA insertion with the triple airway manoeuvre provides wider pharyngeal space and decreases the incidence of epiglottic downfolding by the LMA compared with the standard method.

Keywords

airway: laryngeal mask equipment: airway, laryngeal mask 

Résumé

Cette étude compare avec la méthode d’insertion standard, l’efficacité de la triple manoeuvre de libération des votes aériennes (ouverture de la bouche, extension de la tête et élévation du mandibule) pour l’insertion du masque laryngé (ML). Cent patients paralysés sont répartis au hasard entre deux groupes: dans le groupe contrôle (n = 50), le ML est inséré suivant la méthode standard, et dans l’autre (le groupe TM = 50) suivant la triple manoeuvre. Chez dix patients de chaque groupe, la position du ML et de l’épiglotte est évaluée par radiographie, avant l’insertion, après l’insertion et avant l’insufflation de la manchette, et après celleci. Chez tons les patients, la position a été vérifiée par fibroscopie avant et après l’insufflation. La distance moyenne entre l’épiglotte et la paroi pharyngée postérieure, mesurée par radiographie avant l’insertion du ML, est plus grande dans le groupe TM (16,3 ± ET 4,3 mm) que dans le groupe contrôle (7,0 ± 2,8 mm) (P < 0,001). Avant l’insufflation de la manchette, la radiographie et la fibroscopie montrent que le ML comprime l’épiglotte vers le bas plus fréquemment dans le groupe contrôle. Après l’insufflation de la manchette, la glotte est visualisée dans son entier par fibroscopie chez 66% du groupe TM comparativement à 14% du groupe contrôle (P < 0,001). Un affaissement complet de l’épiglotte est constaté chez 10% du groupe contrôle et chez aucun patient du groupe TM (P < 0,05). Les auteurs concluent que pour l’insertion du ML chez les patients paralysés, la triple manoeuvre procure un espace pharyngé plus vaste et diminue l’incidence de l’affaissement de l’épiglotte par le ML comparativement à la méthode standard.

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Copyright information

© Canadian Anesthesiologists 1995

Authors and Affiliations

  • Kazuyoshi Aoyama
    • 1
  • Ichiro Takenaka
    • 1
  • Takeyoshi Sata
    • 1
  • Akio Shigematsu
    • 1
  1. 1.Department of AnesthesiologyUniversity of Occupational and Environmental Health, Japan, School of MedicineKitakyushuJapan

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